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Disparities Legislation: Once a Decade?

By John Reichard, CQ HealthBeat Editor

May 12, 2008 -- Why, a questioner demanded of Senate staffer Caya Lewis and other panelists at a Capitol Hill forum Monday, is Congress turning a deaf ear to pleas for legislation narrowing racial and ethnic disparities regarding health status and access to care? What will it take to end the "stalemate" over the issue, the questioner earnestly pleaded.

The answer from Lewis: many are unaware of those disparities or don't believe they exist.

Panelists at the event for congressional aides sponsored by the nonpartisan Alliance for Health Reform and The Commonwealth Fund sought to clarify that the problem is very real, and that both federal and state lawmakers can do much to address it. But solving the puzzle goes beyond the big challenge of enacting universal coverage, they noted. And the legislative response needed to deal with its other dimensions is slow to develop, they acknowledged.

The last major piece of disparities legislation was signed into law (PL 106-525) in the year 2000, noted Lewis, a Democratic staffer for the Senate Health, Education, Labor and Pensions Committee chaired by Sen. Edward M. Kennedy, D-Mass. Lewis made no predictions about when the current disparities legislation (S 1576) her boss is co-sponsoring with Sen. Thad Cochran, R-Miss., might make it through Congress, but proponents clearly hope they can at least get it through the Senate this year.

"While people of color make up just one-third of the U.S. population, they comprise over half of the nation's 47 million uninsured individuals," according to a paper co-authored by another panelist, Brian Smedley, research director of The Opportunity Agenda, an advocacy organization that describes its mission as ending racial and gender bias, among other goals. "But even when insured, minority and low-income individuals are less likely to access health care as out-of-pocket costs rise and more likely than are native-born white Americans to face cultural and linguistic barriers to care."

Bruce Siegel, a health policy professor at George Washington University, offered several other statistics illustrating differences in health status and access to health care. Seven of 10 African-Americans are either overweight or obese, compared with about 5 of 10 white Americans and 3 of 10 Asian-Americans, he said. Only 44 percent of Hispanic-Americans go to a private doctor or clinic for their usual care compared with 62 percent of African-Americans and 77 percent of white Americans.

Americans of Asian or Pacific Island descent are more likely to be physically restrained in nursing homes than other racial or ethnic groups, he said. And minorities are less likely than white Americans to receive a pneumococcal vaccination, he said.

But Siegel also noted that certain policy initiatives make a difference. For example, programs to improve the quality of care in dialysis facilities are associated with improved quality overall and with smaller disparities in care between black and white patients. And having a "medical home," a current hot topic in policy circles, is important, he indicated. Having a medical home means having a doctor or practice that monitors one's overall care and emphasizes preventive practices, among other goals. Minorities with medical homes are just as likely as whites to receive reminders for preventive care visits, he said.

Smedley presented an analysis of states that have made or pursued health care system changes to draw lessons on how to reduce disparities. “Coverage expansions are necessary but not sufficient to promote health care equity,” he said. Other methods include promoting diversity among health care professionals; minority professionals are more likely to practice in underserved areas. Streamlining enrollment procedures also helps boost enrollment in publicly funded health care programs, he said. And "outreach" programs to find potential enrollees need to be evaluated, he said.

Panelists made the point that having an insurance card doesn't mean a local doctor or other provider will be available nearby. Assuring that "infrastructure" means supporting safety net institutions such as community health centers and providing incentives such as loan repayment for practicing in underserved areas, Smedley said.

To get federal legislation untracked, Lewis stressed the importance of reaching across the aisle to find common ground. She noted that Kennedy has worked well with Cochran, who is "great" on the issue because of his knowledge of health care disparities in the Mississippi Delta.

"One of the clear things we can do at the federal level is improve the training of minority health professionals," she noted. The seemingly dry topic of data collection also is key because it helps clarify specific aspects of disparity, panelists noted. Among other objectives, the Kennedy-Cochran bill would boost training efforts and standardize the way federal health programs collect data pertaining to race and ethnicity. It also would help fund community programs targeting disparities and require a national plan to improve minority health and eliminate disparities.

Becky Shipp, a GOP staffer with the Senate Finance Committee, said she agreed that the disparity problem is real and that expanding coverage options should not be the only policy option. Shipp, who said she was speaking for herself and not for her boss, added that expanding programs such as the State Children's Health Insurance Program to include higher income levels had undesirable effects such as crowding out private coverage.

But she agreed that this "is the season for health reform" and said the current system is "unsustainable." She also offered some encouragement. Health policy "is really hard. It's really hard to get stuff done." But "every once in a while you capture lightning in a bottle."

Lewis similarly suggested that steady effort would pay off in gaining passage of disparities legislation. "It takes a while, but it shouldn't be once every 10 years," she said.

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